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Up to 86% Lose PTSD Diagnosis with Trauma-Focused Psychotherapy
Systematic review of 34 randomized trials finds EMDR most effective, though civilians were more likely than veterans to lose their PTSD diagnosis after treatment.
About 65% to 86% of participants lost their PTSD diagnosis after receiving evidence-based psychotherapies, with eye movement desensitization and reprocessing showing the most benefit, a recent study found.1
“The results of this systematic review and meta-analysis supplement the current literature on PTSD treatments and indicate that each of the trauma-focused treatments resulted in higher proportions of diagnosis loss than [present-centered therapy] or [waitlist or minimal attention],” wrote investigators, led by Tiffany Milligan, PsyD, MBA, from the Psychological Health Center of Excellence, Defense Health Agency at Falls Church, Virginia.
A survey with a nationally representative sample of the general US population estimated a lifetime PTSD prevalence of 6% and a 1-year prevalence of 5%.2 For veterans, a 2019 – 2020 National Health and Resilience in Veterans study reported a lifetime PTSD prevalence of 9.4%.3
Over the last 4 decades, many psychotherapies have been developed and adapted to target PTSD, such as cognitive behavioral therapy (CBT), cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing (EMDR). Trials have often used present-centered therapy as an active control.1 The psychotherapies, although effective in randomized controlled trials, have little data on its success in real-world clinical practice.
Investigators sought to estimate the percentage of patients who no longer met the PTSD criteria after treatment. They used the PTSD Respiratory to identify studies evaluating adults with a DSM-IV/DSM-5 PTSD diagnosis. The studies reported the number of participants who did not meet the diagnostic criteria for PTSD post-treatment.
The systematic review included 34 randomized clinical trials, with 3208 participants. Participants fell into 3 categories: in the military, a veteran/milvet, or no involvement with the military.
The team reviewed prolonged exposure and CBT in 9 trials, cognitive processing therapy in 6 trials, EMDR and present-centered therapy in 5 trials, cognitive therapy for PTSD in 3 trials, and 16 waitlist or minimal attention trial arms. They analyzed diagnosis loss between October 2023 and June 2024 via mixed-effects logistic regression models.
Compared with individuals with no military background, fewer veterans completed cognitive processing therapy and prolonged exposure without a PTSD diagnosis; only 44% to 50% of veterans no longer met criteria for PTSD after treatment.
Patients with no military involvement had the greatest success with EMDR and cognitive therapy for PTSD, with diagnosis loss rates at 86% (95% CI, 72% - 93%) and 76% (95% CI, 67% - 83%), respectively. However, these studies did not include veterans, nor were they conducted in the US.
“While our findings indicate possible superiority of EMDR with respect to diagnosis loss, this warrants further research,” investigators wrote.
The control, present-centered therapy, showed the lowest proportion of diagnosis loss (28%; 95% CI, 21% - 36%).
For the other treatments, 61% (95% CI, 44% - 76%) who had undergone CBT and 13% (95% CI, 8% - 20%) who were on the waitlist or received minimal attained no longer had a PTSD diagnosis after therapy.
“Diagnostic loss data are a relatively straightforward way to communicate potential treatment benefits with patients,” investigators concluded. “Thus, these data may be useful to clinicians and patients when selecting treatments and assessing barriers to progress. The differences seen in terms of milvet status indicate opportunities to better understand the reasons underlying these differences and to examine how EMDR and [cognitive therapy for] PTSD perform with milvet samples.”
References
Milligan T, Smolenski D, Lara-Ruiz J, Kelber MS. Loss of PTSD Diagnosis in Response to Evidence-Based Treatments: A Systematic Review and Meta-Analysis. JAMA Psychiatry. Published online May 21, 2025. doi:10.1001/jamapsychiatry.2025.0695
Goldstein RB, Smith SM, Chou SP, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1137-1148. doi:10.1007/s00127-016-1208-5
Wisco BE, Nomamiukor FO, Marx BP, Krystal JH, Southwick SM, Pietrzak RH. Posttraumatic Stress Disorder in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study. J Clin Psychiatry. 2022;83(2):20m14029. Published 2022 Feb 22. doi:10.4088/JCP.20m14029
